[Whooping cough: a retrospective study of the cases diagnosed over a period of 15 years]. / Tos ferina: estudio retrospectivo de los casos diagnosticados en un período de 15 años.

OBJECTIVE: Our objective was to study the whooping cough cases diagnosed in a 15-year period in our hospital, referring to its clinical features, epidemiology and analytical findings. PATIENTS AND METHODS: A retrospective study based on 144 cases with a clinical diagnosis of whooping cough, from 1981 to 1995, was carried out. Special attention was paid to those cases with cultures positive for B. pertussis. RESULTS: Nasopharyngeal specimens for culture were taken in 119 cases. This was not carried-out in those with previous antibiotic therapy. Cultures were positive for B. pertussis in 46 patients (38.7%). The age varied between 20 days and 30 months. Twenty-one were female. The initial symptoms were: paroxysmal cough in 44 (95.7%), cyanosis in 34 (73.9%), inspiratory whoop in 27 (58.7%), respiratory distress in 12 (26.1%) and post-tussive vomiting in 10 (21.7%). Thirty-nine children (84.8%) of this group had not received any pertussis vaccine, the rest had received just the first dose. It had been contacted by persons having cough in 19 patients (41.3%). Leukocytosis (mean: 19,818/mm3), lymphocytosis (mean: 13,047/mm3) and high platelet count (mean 459,522/mm3) were common findings. CONCLUSIONS: Cultures were positive in 38.7% of the patients. There are similar findings by other authors. In this group, most of the children were unvaccinated, and less than 3 months of age. Typical symptoms of pertussis were observed in the majority of patients. In one forth of them respiratory distress was found, probably related to their young age. Vaccinated adults emerge as a contact group that should be studied.

[Brain stem encephalitis in childhood]. / Encefalitis de tronco cerebral en la infancia.

OBJECTIVE: To present two cases of post-infectious encephalitis of the brain stem (ETC) in infancy, which is very infrequent at this age. CLINICAL CASES: Two patients aged 4 months and 9 months respectively had a previous history of a catarrhal illness a few days before the onset of encephalitis. The clinical condition was of subacute onset and torpid course, characterized by ataxia, reduced level of consciousness, involvement of the pyramidal tracts and paralysis of the cranial nerves. No significant information for the diagnosis of either case was obtained from CT. MR showed lesions at the level of the pons. However, the MR image did not correspond in seventy to the clinical condition. The clinical courses of the two patients were different. One case recovered with no sequelae. In the other case the cranial nerves and gait did not return to normal. CONCLUSIONS: In our experience, ETC is rarely seen in infancy. A high degree of suspicion and early treatment of ETC caused by the herpes simplex virus is necessary, since there is usually a high mortality or serious neurological sequelae.

[Pulmonary tuberculosis in children: its age-dependent aspects]. / Tuberculosis pulmonar en el niño: características según la edad.

OBJECTIVE: The aim of this study was to investigate the clinical and radiological particularities of pulmonary tuberculosis depending on the age of the child. PATIENTS AND METHODS: The medical records of all children with pulmonary tuberculosis diagnosed between 1985 to 1996 were reviewed. They were divided into three age groups according to age: < 3 years, 3-5 year and 6-15 years. RESULTS: Of the 173 children identified, 51.4% were male. Forty percent were < 3 years if age, 33.1% between 3 and 5 years and 26.1% between 6 and 15 years old. The frequency of diagnosis derived from a case contact investigation was higher in children < 3 years of age (38.6%) and children aged 3-5 years (52.6%) than in children between 6-15 years old (21.7%, p < 0.05 for both). In the other cases, diagnosis was the result of investigation of an ill child, investigation of a child after pulmonary tuberculosis was diagnosed in a sibling and routine tuberculin skin test reactivity. An adult source of tuberculosis was identified in 68.6% of the children < 3 years old, 59.6% of children aged 3-5, but only in 37% of the children aged 6-15 years (p < 0.05 for both). The case contact was a family member in 92.7% of the children < 6 years of age and in 66.7% of children aged 6-15 years (p < 0.01). Culture of Mycobacterium tuberculosis was positive in 47.1% of children < 3 years old and 43.9% of children aged 6-15 years, but only in 27.5% of children aged 3.5 years (p < 0.05). Pulmonary parenchymal disease was more frequently found in children < 3 years (67.5%) than in children aged 6-15 years (39.4%, p < 0.05). CONCLUSIONS: Investigation of an adult source is essential when a child is diagnosed of pulmonary tuberculosis. Pulmonary tuberculosis is more intense and the source of adult contact is more frequently found in children < 3 years old.

Tolerance of pyrazinamide in short course chemotherapy for pulmonary tuberculosis in children.

BACKGROUND: This prospective study was performed to evaluate the tolerance of pyrazinamide in short course chemotherapy in children. METHODS: A total of 114 children ages 6 months to 15 years (4.5 +/- 3.4 years) with diagnosed pulmonary tuberculosis from 1985 to 1995 entered the trial. A 2-month regimen of isoniazid, rifampin and pyrazinamide, followed by rifampin and isoniazid for the remaining 4 months, was administered orally to all children. Clinical adverse effects specifically investigated were gastrointestinal disturbances, rash, signs of hepatotoxicity and arthralgias. Laboratory toxicity data (number of leukocytes, erythrocyte sedimentation rate, aspartate aminotransferase, alanine aminotransferase and serum uric acid) were collected before treatment and 1, 3 and 5 months after the beginning of chemotherapy. RESULTS: Clinical adverse effects were mild in all cases. Three children (2.6%) had fever and 5 (4.4%) had gastrointestinal disturbances. Aspartate aminotransferase and alanine aminotransferase mean values showed no differences along time and no patients had clinical signs of hepatotoxicity. Only 11 children (19.6%) showed a slight increase in alanine aminotransferase (< 194 units/l). Serum uric acid increased in 92.2% of the children compared with pretreatment values. This increase remained within the normal range in all but 9.8% of patients. There was a significant increase in uric acid mean concentrations after 1 month of therapy (from 3.7 +/- 0.7 mg/dl to 5.7 +/- 1.6 mg/dl, P < 0.05), which fell again (4.0 +/- 1.1) 1 month after pyrazinamide was stopped. There were no signs of gout or arthralgias. In no case was the treatment interrupted. CONCLUSION: The addition of pyrazinamide in chemotherapy for pulmonary tuberculosis in children was found to be safe. The slight increase in uric acid concentration during its administration had no recognized adverse consequences.

[Encephalitis due to measles]. / Encefalitis por sarampión.

OBJECTIVE: We present seven cases of acute encephalitis following measles, which were diagnosed during the epidemic that occurred in Spain in 1986. PATIENTS AND METHODS: We studied seven patients diagnosed of encephalitis due to measles. The diagnosis of measles was a made by the presence of a characteristic morbiliform rash and the detection of specific IgM antibodies. The diagnosis of encephalitis was based on the symptoms and the routine examinations of blood, CSF, EEG, CT, ophthalmic exploration and the study of the audiovisual evoked potentials. RESULTS: The patients were between 5 and 9 years of age. None of them had been previously vaccinated for measles. The symptoms of encephalitis occurred 1 to 12 days after the appearance of the rash and the most frequent symptoms were drowsiness and vomiting. All of the patients had EEG abnormalities that returned to normal 1 to 18 months after the diagnosis. One patient presented CT abnormalities. CSF examination revealed an increase of the cell count in one case. The ophthalmic exploration was normal except in one of the patients which had optic neuritis. There were no abnormalities in the audiovisual evoked potentials. All of the cases showed good evolution. Five years later, all of the patients have had a normal development. CONCLUSIONS: The correct vaccination of measles can eradicate this disease.

[Kawasaki disease; complications and clinical course. Apropos of 38 cases]. / Enfermedad de Kawasaki; complicaciones y evolución. A propósito de 38 casos.

Between January 1978 and December 1991, 38 patients who fulfilled the CDC (Center for Disease Control) criteria for Kawasaki syndrome were admitted to our hospital. We reviewed the clinical data, laboratory tests, ECG and serial echocardiographic studies in order to establish the characteristics of the disease in our environment. There were 23 males and 15 females. The age at presentation ranged from 4 months to 10 years (mean 3.5 years). Extracardiac complications were as follows: arthritis in 12 patients, vesicular hydrops in 2, urinary tract infection in 1 and lymphocytic meningitis in 1. Cardiac involvement was frequent, with 35% of the patients being diagnosed with coronary pathologies (dilatation of coronary arteries in 9 and aneurysm formations in 4). The most usual location of these anomalies was in the left main coronary artery. By the end to the follow-up period, 71% of the lesions had disappeared. The time necessary for this regression was related to the size of the abnormalities. The high incidence of cardiac involvement make it necessary to follow these patients for a period of time in order to prevent or to treat the later occurring sequelae.

[Chemoprophylaxis of tuberculosis: compliance to treatment in the pediatric population]. / Quimioprofilaxis tuberculosa: grado de cumplimiento en la población pediátrica.

We have reviewed the success of tuberculosis chemoprophylaxis in 369 children. These children ranged from 4 months to 14 years of age and had been prescribed chemoprophylaxis with Isoniazide at 10 mg/kg/day. Out of these, 258 (69.91%) finished the prophylaxis and 111 (30.08%) did not. Taking into account the reason for the consultation, of those who sought assistance due to contact with a patient with tuberculosis, 70.33% performed the treatment and 29.60% did not. For those in which the reason was a positive Mantoux, the data were 68.1% and 30.8%, respectively. No statistically significant differences were found between the two groups. We feel that the relatively high rate of noncompliance in our patients is a matter of concern. At the present time, chemoprophylaxis with Isoniazide is the best method available for the prevention of tuberculosis. We emphasize the need for its proper performance. We report several measures, such as the determination of Isoniazide metabolites in urine, which may be beneficial for better control and follow-up of these patients.

[Bronchoscopy in pulmonary tuberculosis in children]. / Broncoscopia en la tuberculosis pulmonar del niño.

We retrospectively analyzed thirty-seven cases of infantile pulmonary tuberculosis that had been subjected to bronchoscopy. Although this exploration produced evidence of bronchial wall irritation, the macroscopic findings, as well as the histological ones, were frequently insufficient to make the diagnosis of tuberculosis. The bacteriological study of bronchial exudates of these patients was more efficient since we encountered BAAR in 34.2% of the samples.

[Contacts of children with tuberculous patients]. / Contactos infantiles de enfermos tuberculosos.

One hundred and nine adults recently diagnosed of active pulmonary tuberculosis (all of them with smear positive sputum) were selected. Their household contacts under fifteen years of age were studied. 73.1 por 100 of the children were tuberculin-positive, and 33.1 por 100 of these "reactors" had developed a pulmonary tuberculosis themselves. The bacillary density in the sputum of the source case was correlated to percentage of infected and ill children among his contacts. Neonatal vaccination with BCG showed a protective effect against the illness in children under eight years of age.

[IgG2 deficiency associated with recurrent pneumonia and asthma (review of an IgG subclass)]. / Déficit de IgG2 asociado a neumonías de repetición y asma. (Revisión de subclases de IgG).

Very low levels of IgG2 were detected in a 7 1/2 years old girl affected by recurrent pneumonias and atopic related disease. A similar clinical picture was present in two siblings (of 9 and 4 years old), although their of IgG subclass deficiencies is made, with special emphasis on IgG2 and their relationship with recurrent sinopulmonary infections, atopy and other immunodeficiencies.

[Pulmonary tuberculosis in infants: apropos of 149 cases]. / Tuberculosis pulmonar en la infancia: a propósito de 149 casos.

One hundred and forty-nine cases of childhood pulmonary tuberculosis were analysed being a 77.6% of the 192 cases of tuberculosis diagnosed at the Pediatric Infectious Diseases Department of "La Paz" Hospital, in a ten year period. The children were aged 3 months to 14 years; 65% of them were less than 6 years of age. The source case was found in 67.1% of the children. The primary means of diagnosis was contact screening (38.1%), followed by a 27.5% that presented with non-specific symptoms, while 18.1% of the cases presented with respiratory symptoms. Gastric aspirates yield the organism in 25.8% of cases. Radiologically the following was found: 38.9% mixed patterns, 32.2% nodal patterns, 23.4% parenchymal patterns, 1.34 miliary tuberculosis, 1.34% caverns and 2.68% pleural effusions. Right lung location was more frequent in parenchymatous forms (68%), as well as in nodal forms (61.5%). The duration of the course of therapy changed along this ten years period: from twelve months initially to ten months posteriorly, subsequently becoming a six month course of treatment. All cases experienced full recovery.

[Short term treatment of infantile pulmonary tuberculosis]. / Tratamiento de corta duración de la tuberculosis pulmonar infantil.

Due to the scarcity of published articles on short-course chemotherapeutic regimens for pediatric pulmonary tuberculosis, the following study has been carried out: Twenty-five children diagnosed of pulmonary tuberculosis were administered a short course therapeutic regimen consisting of three tuberculostatics for the first two month (isoniazid, rifampicin and pyrazinamide) and only two (isoniazid and rifampicin) for the following four months. The results were compared with those obtained from a control group of twenty-five children receiving the "classical" therapy: two drugs (isoniazid and rifampicin) for a nine month period. The statistical analysis did not demonstrate any significant difference related to evolution, duration and complications of the disease, between both groups. Therefore, this short course therapeutic regimen could be accepted for pediatric pulmonary tuberculosis.